Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-5262
2. Registrant Information.
Registrant Reference Number: Prosar 1-20509212
Registrant Name (Full Legal Name no abbreviations): The Hartz Mountain Corporation
Address: 400 Plaza Drive
City: Secaucus
Prov / State: New Jersey
Country: USA
Postal Code: 07094-3688
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
23-OCT-09
5. Location of incident.
Country: UNITED STATES
Prov / State: LOUISIANA
6. Date incident was first observed.
15-OCT-09
Product Description
7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.
Active(s)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 2596-140
Product Name: UltraGuard Plus Flea/Tick Spray for Cats 8 fl oz
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .07 %
- TETRACHLORVINPHOS
- Guarantee/concentration 1.08 %
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Animal / Usage sur un animal domestique
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
The product was applied to the kitten on 10/09/2009 and 10/13/2009.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Shorthair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
0.25
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Ataxia
- Symptom - Difficulty walking
- Renal System
- Symptom - Urinary incontinence
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
No
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Died
16. How was the animal exposed?
Treatment / Traitement
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-20509212: A reporter (cat owner) called on 10/23/2009 to report the exposure of his cat to a flea and tick spray containing the active ingredients Methoprene and Tetrachlorvinphos. According to the reporter, the kitten was spayed on 10/08/2009 but had not been given a flea bath at that time as requested by the reporter. The reporter applied the product to the kitten on 10/09/2009 to treat the flea infestation. The product was re-applied on 10/13/2009 for persistent fleas. By 10/15/2009, the kitten was ataxic, unable to walk, vocalizing, and urinating "all over the place." The kitten was evaluated by a veterinarian on 10/16/2009. The kitten was sent home with the reporter and the reporter was advised to bathe the cat. The reporter bathed the kitten in dish soap, but she died 1 hour later. The reporter was advised that the signs described are not expected with routine use. The company's reimbursement policy was discussed. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here